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Chapter 1: About Drugs in General    
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Recognising Headache-Causing Situations

In case of frequent headaches, it is advisable to maintain a record of every headache you suffer from. The points to be noted are date, day and place of occurrence, time of onset, duration, warning signs before occurrence, type and severity of pain, other symptoms, mood of patient before onset, food/medicines etc., taken before occurrence, activities done before occurrence and source of relief.

Keeping such a record will help the doctor find the correct type/cause of headache and treat it accordingly.

Management of Headaches

The more well-known analgesics, namely paracetamol, aspirin and ibuprofen, are usually used to treat occasional and/or mild headaches. Severe headaches like migraines and cluster need other specific drugs (which the doctor prescribes). Tension or Muscle Contraction headaches can be managed by understanding the cause of pain and using self relaxation which can be done in any of the following ways:

-

Lying down in a dark room

 
- Taking a nap  
- Listening to music  
- Taking a hot water bath  
- Yoga and meditation  
- Exercise  

Treatment of Pain

The most widely used analgesics for mild-pain are aspirin and paracetamol.

Aspirin is the analgesic of choice for headache, muscular pain, bone and joints pain and pain due to menstruation. It also has helpful anti-inflammatory (reduces swelling) and antipyretic (reduces fever) properties, which are exhibited at somewhat higher doses.

Its drawbacks are that it causes stomach irritation (which can be minimized if taken after food) and hence it is not used to treat abdominal pain or pain associated with nausea and vomiting. It is also not to be used in children below 12 years of age.

Paracetamol is similar in efficacy to aspirin but has no anti-inflammatory activity. However, it is less irritant to the stomach as compared to aspirin. It can be used in children. Its overdose is dangerous as it causes severe liver damage.

Non-Steroidal Anti-inflammatory analgesics (NSAIDs) are used to treat patients with chronic diseases accompanied by pain and inflammation, for example, arthritis, secondary bone tumors, etc. They include drugs like ibuprofen, naproxen, piroxicam, diclofenac, indomethacin, diflunisal, etc. They differ in efficacy and side-effects. Ibuprofen is widely used. It has fewer side-effects than other NSAIDs but its anti-inflammatory properties are weaker. Whereas the side-effects of indomethacin are very many.

NSAIDs must be used with caution in the elderly, pregnant, asthmatic, allergic, cardiac and renal and/or hepatic impairment patient. They like aspirin, cause stomach irritation and must be avoided in ulcer patients.

Narcotic analgesics, also known opioid analgesics, are the most powerful analgesics. However, they have harmful side-effects and habit forming potential and hence not used for mild pain. They are used to treat pain arising from surgery, serious injury and disease. They are valuable for alleviating severe pain during terminal illnesses, e.g., cancer.

Morphine is the most well known narcotic analgesic. Others are diamorphine (heroin), pethidine, phenazocine, etc. The use of these powerful narcotic analgesics is strictly controlled as they produce euphoria, which can lead to abuse and addiction. But when they are used under medical supervision for treatment of severe pain for a short period of time, the risk of addiction is very little.

There are less powerful drugs in this group which are used to relieve mild to moderate pain, e.g., codeine (which though effective is too constipating for long-term use) and dextropropoxyphene (a mild analgesic and less potent than codeine).

Combination Analgesics

Although there are many combination analgesic products (like Brufen, a combination of paracetamol and ibuprofen) available in the market, there is little evidence that such products are more effective than the single drug. Besides they combine the side-effects of both drugs. Hence it is advisable to use a single analgesic which is effective rather than using combination products.

Antibiotics

Penicillin, the first antibiotic, was discovered in 1941. Since then many new and different classes of antibiotics have been introduced. Each antibiotic is a different chemical entity and is effective against a broad or specific spectrum of bacteria, used in the treatment of specific organisms. Antibiotics and antibacterials are not effective against viruses.

Bacteria are present all around us - in the air we breathe, in the mucous membranes of the mouth and nose, on the skin, in the intestines. Our natural immunity protects us from them. But when our immunity breaks down, or when bacteria already present migrate to a vulnerable new site, or when harmful bacteria not usually present invade the body, infectious disease sets in.

Bacteria multiply rapidly, destroying tissue, releasing toxins and, in some cases, threatening to spread via the bloodstream to such vital organs as the heart, brain, lungs and kidneys. The symptoms of infectious disease, although they almost always include fever, vary widely, depending on part of the body infected and the type of bacteria.

The exact kind of bacteria infecting a person can only be confirmed by tests of the person's blood, sputum, urine, stool or pus. These can take up to 24 hours or more. In the absence of such tests, the doctor usually makes an educated guess and may prescribe a broad-spectrum antibiotic, that is an antibiotic that works against a wide range of bacteria.

With more exact information from the laboratory tests confirming the nature of the bacteria, the doctor may then switch to an antibiotic that is the recommended treatment for the identified bacteria. Sometimes more than one antibiotic is prescribed to be sure of eliminating all strains of bacteria.

Antibiotics come in the form of tablets, capsules, liquids, dry syrups, or injectables. The last is normally used in critical cases. There are also antibiotic that are topical preparations used for skin, eye and ear infections.

Antibiotics either kill organisms directly (bactericidal), or enabling the body's natural defences to overcome the remaining infection.

There are two main mechanisms of action: penicillins and cephalosporins destroy bacteria by preventing them from making normal cell walls; most other antibiotics act inside the bacteria, interfering with the chemical activities essential to their life cycle.

     
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